- Molina Healthcare (FL)
- …and prepares written response to incoming provider reconsideration requests related to claims payment, requests for claim adjustments, and/or requests from ... JOB DESCRIPTION Job Summary Provides support for claims activities including reviewing and resolving member and provider complaints, and communicating resolution to… more
- Highmark Health (Tallahassee, FL)
- …requests, and drug claim edits/prior authorizations. By reviewing member claims history, clearly defines the medical necessity of non-formulary and ... and/or assist in addressing denied point of sale prescription claim transitions and coordination of benefits practices/procedures. **ESSENTIAL RESPONSIBILITIES** +… more
- MetLife (Tampa, FL)
- …office for meetings Key Responsibilities: * Effectively manage a team of STD Claim Specialists in a fast-paced environment to ensure individual and team performance ... indicators and delivering on customer commitments through quality and timely claim determinations including compliance with ERISA and other state and regulatory… more
- UNUM (Tallahassee, FL)
- …Physical Medicine and Rehabilitation. This position is responsible for providing expert medical analysis of claims files (or underwriting applications) across ... and efficient medical consultative services to the Benefits Center. The Medical Consultant adheres to current regulatory, claim process, and internal… more
- Elevance Health (Tampa, FL)
- …coding or quality assurance environment preferred. + Broad knowledge of medical claims billing/payment systems provider billing guidelines, payer reimbursement ... -expense spending. The **DRG CODING AUDITOR** is responsible for auditing inpatient medical records and generating high quality recoverable claims for the… more
- Sedgwick (Tallahassee, FL)
- …**:** To supervise the activities of the adjuster department; to assign caseload of claims to adjusters and to ensure customer satisfaction of claims services ... + Develops standards, programs, processes, and initiatives to assure quality claim files and results. + Resolves complaints and problems which have… more
- CVS Health (Orlando, FL)
- … claims , provide new hire training, resolve escalations and claim payment denials while demonstrating excellent customer service to patients, healthcare ... the Orlando area has an opportunity for a full-time Medical Collections Team Lead. As a Medical ...Provide new hire training and maintain training documents. + Claims Collection Management: Lead the team in collecting or… more
- BrightStar Care (Naples, FL)
- …a database using this set medical protocol to produce a statement or claim . * Investigate rejected claims , verify this information with the health provider, ... years . We are looking for the an experienced medical Billing and Payroll Specialist . Responsibilities include weekly...payroll.. Managing Authorizations , appeals and re- submission of claims . Posting cash etc. Must be detail oriented… more
- MyFlorida (Alachua, FL)
- …admission. Assist all accredited organizations, state, county or others in obtaining medical information necessary to support claims for benefits. Maintain ... medical center staff as required. Safeguard and protect all private medical information and claims information in accordance with appropriate regulations and… more
- Guidehouse (Tampa, FL)
- …edits such as: + Correct Coding Initiatives (CCI) + Medically Unlikely Edits (MUE) + Medical Necessity edits + Other claim level edits as assigned + As needed, ... third party payer accounts that are subject to pre-bill claim edits, hospital billing scrubber bill hold edits, and...and reporting requirements including resolution of CCI, MUE and Medical Necessity edits applied to claims . +… more